Public Bill Committee

[Mr. Christopher Chope in the Chair]

Clause 154

Arrangements under section 153(1)

Amendment proposed [this day]: No. 201, in clause 154, page 110, line 17, at end insert
‘and who does not commission or provide local care services’.—[Alistair Burt.]

Question again proposed, That the amendment be made.

Christopher Chope: I remind the Committee that with this we are taking the following: Amendment No. 183, in clause 154, page 110, line 17, at end insert—
‘( ) In making arrangements, A may select as H either the National Health Involvement Network or such other person who in the opinion of A is able to deliver such an arrangement under section 153(1) so that it meets the general duty as set out in section 3 of the Local Government Act 1999.’.
 Amendment No. 184, in clause 154, page 110, line 27, at end insert—
‘( ) The arrangements must provide that a local involvement network is provided with the staff, premises and resources that are necessary in the opinion of A for the local involvement network to carry on in A’s area activities specified in section 153(2).’.
New clause 15—National health involvement network—
‘(1) There shall be a body corporate to be known as the National Health Involvement Network to exercise the functions set out in section 153(2) to (5).
(2) The National Health Involvement Network has the following functions—
(a) advising the Secretary of State, and such other bodies as it may consider appropriate, about arrangements for promoting the involvement of people in the commissioning, provision and scrutiny of care services;
(b) representing to the Secretary of State, and such other bodies as it may consider appropriate, and advising him and them on the views in England of people about their needs for, and their experiences of, care services;
(c) representing to the Secretary of State, and such other bodies as it may consider appropriate, and advising him and them on the views of local involvement networks in England on their activities as respects section 153(2);
(d) facilitating the coordination of the activities of local involvement networks;
(e) advising and assisting local involvement networks in England;
(f) setting quality standards relating to any aspect of the way local involvement networks exercise their functions, monitoring how successfully they meet those standards, and making recommendations to them about how to improve their performance against those standards;
(g) promoting the involvement of people in the commissioning, provision and scrutiny of care services;
(h) such other functions in relation to England as may be prescribed.
(3) The Secretary of State shall by regulations make further provision in respect of the National Health Involvement Network and these may include such matters as status, powers, membership, appointment, staff, payments to, accounts, audit and reports.’.

Patrick Hall: We have had the opportunity to have lunch, and I shall now conclude the remarks that I was about to make when we adjourned.
My hon. Friend the Minister has approached the Committee’s work with an open mind, and has been helpful and honest. It was not that that was new this morning, because we have been getting used to his approach throughout the Committee, but he injected the new and enlightening suggestion that Ministers should agree with proposals that they advocated. The hon. Member for North-East Bedfordshire showed some surprise at that suggestion, and I wonder what his reaction would be if I mentioned the Child Support Agency. Perhaps that is a little unfair.

Alistair Burt: The hon. Gentleman was reading my expression as I was being teased. We had the tantalising prospect of the Minister announcing that he was thinking through a colleague’s policy before concluding whether it was right. That raised the prospect in our minds of him going to the Department of Health, knocking on the Minister’s door, and saying, “Rosie, I just can’t do this.” He then let us down by saying that having thought the matter through carefully, surprisingly, he agreed with his colleague. That was the surprise that the hon. Member for Bedford detected.

Patrick Hall: Even more enlightenment is shining upon us today, and I thank the hon. Gentleman for his comments.
 Turning to the matters of greater substance that are before us, and the need to set up a national top-down body—that is proposed in my amendment—I understand the arguments and the logic for not accepting that, but the need for a national dimension to assist local involvement in health networks in doing their job remains, and the case for that is strong. On day one of LINKs’ existence, there will be no such body, and if they eventually get together and create a membership organisation, they will need the resources to do so. I urge my hon. Friend the Minister to bear that in mind. Funds must be sufficient for that task.
 My hon. Friend did not have time to deal with the issues that I raised on amendment No. 184, and perhaps they can be looked at elsewhere. The question in my mind, having dangerously dipped into the draft contract documents that were made available last week, is whether it might be possible for the role of the host to be more significant than that of the LINK. We shall have to explore that further, but there has been sufficient movement on these matters and acknowledgement of their importance for me not to press the amendments.

Alistair Burt: The Minister addressed his hon. Friend’s amendments well, but I just want to indicate the purpose of my amendment No. 201—he may want to intervene—because I stumbled over it, and he may not have picked up its purpose.
 The clause makes it clear that a local authority could not be a host organisation, but does not make it specifically clear that any other provider of care services—such as a national health service organisation—could not be a host organisation. The point of the amendment is to indicate that it would be just as awkward for the independence of LINKs if they were hosted by an NHS or any other organisation providing services as it would be if they were hosted by a local authority.
That is the purpose of my amendment, and I would be grateful if the Minister could help me out on that.

Phil Woolas: The hon. Gentleman makes an important point. The amendment would insert the words
“and who does not commission or provide local care services”.
Clause 154 does not allow a local authority or an NHS trust to be a LINK. It is possible as we stand that the host may be a local health organisation.

Alistair Burt: I appreciate that. In that case, my amendment has not been covered. The point of the amendment was to say that the same logic would surely apply. If the Minister and the Department did not feel that a local authority was an appropriate host because it also provided services, surely it would be equally logical that, as well as not being a LINK, other such organisations should not be a host either. If the Minister and the Department do not agree, I will welcome an explanation of why there is an inconsistency between the two. I am not satisfied that the point has been dealt with.

Phil Woolas: The hon. Gentleman has a point. I think that that will be covered in the next group of amendments. We may be able to debate it and seek the views of the Committee at that point.

Alistair Burt: In view of that, we can always consider the point further, so I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

John Pugh: I beg to move amendment No. 228, in clause 154, page 110, line 26, at end insert—
‘(h) any organisation providing local care services.’.

Christopher Chope: With this it will be convenient to discuss amendment No. 229, in clause 154, page 110,line 29, at end insert—
‘(7) No chair of an organisation listed under subsections (4)(d) to (4)(h) shall also be a leader of a Local Involvement Network.’.

John Pugh: I shall be as brisk as I can, because some of the territory has been covered.
I have a lot of sympathy for the Minister. He has been endowed with the brilliant idea of LINKs by the Department of Health, and has done his best to explain it with as much clarity as possible. The idea remains fundamentally unclear to a number of us. I understand that a LINK is an organisation that can morph—I think the Minister used the word “flexible”. In other words, it can co-opt people as and when it wants; it is a moveable feast. It is not like a forum or a community health council, with an established or defined membership—a core membership was the expression used by the hon. Member for Bedford—but it is said to be more versatile, more potent and more effective in some ways. We all find the absence of defining regulation just a little worrying. I accept the Minister’s response, which was that all will be defined by some sort of contractual arrangements when LINKS are established. As we are unfamiliar with the contracts that will be established, we are none the wiser about what a LINK will be.
We seem to know what a LINK is not, and what it cannot be. A list of conditions in paragraphs (a) to (g) gives various things that it definitely is not. That list is a mixed bag, which covers providers, commissioners, some things that are trusts and some that are not, but it does not seem to be complete. Private providers, who are now clearly part of the health service, are omitted. That might have been what amendment No. 201 was getting at. I will not go over the arguments in connection with that. There seems to be a benefit in specifying a level playing field, even though I think it pretty unlikely that any private provider would wish to become a LINK or would be acceptable as one.
Amendment No. 229 follows up on a point raised by the hon. Member for North-East Bedfordshire, which is the spectre of Joe Public coming along to his first LINK meeting and finding himself surrounded by health officials, health professionals and health apparatchiks of one kind or another, and feeling restrained in what he could say. The legislation lays out quite clearly that trusts cannot be LINKs, but it does not seem to lay out so clearly what trust members can be or cannot be. I have had occasion to observe that people who belong to one quango reappear almost magically in another. If they are affiliated to one organisation, they get themselves affiliated to an associated organisation.
Amendment No. 229 attempts to make it clear that, whoever is on the LINK, it will not be people with a prominent position on any of the trusts. In considering the matter, I decided that there is not an overwhelming case for excluding all trust employees, because an awful lot of people work for the health service in one capacity or another; the result would be the exclusion of enormous numbers of people and of a wide range of relevant expertise.
 The hon. Member for North-East Bedfordshire alluded to the fact that there are occasional possibilities for conflicts of interest. For example, if a midwife were a LINK member—I cannot see why she should not be—what would be the appropriate course of conduct if the subject of discussion were the closure of maternity units? Likewise, what would be the appropriate course for ambulance people if the positioning of an accident and emergency department were under discussion? Those are relevant issues, and amendment No. 229 is intended to probe how conflicts of interest will be addressed.
Amendment No. 228 would add what I believe to be a necessary completing provision to the proposed legislation. If health providers are to be excluded in general, let us exclude all of them, rather than just those that are NHS trusts.

Phil Woolas: A number of amendments have been proposed on the issues of who can or cannot be a LINK, on hosts and on conflicts of interest.
Amendment No. 228 would include independent sector providers in the list of bodies that cannot become a LINK. The Government have an open mind on the amendment, because one can see its purpose exactly. Let us take the case of a BUPA hospital—not that the Government have anything against BUPA hospitals. Clearly, there would be an inconsistency if the clause as currently drafted did not allow an NHS foundation trust to be a LINK, yet allowed an independent hospital to become a LINK. One can see that there might be circumstances in which a local authority would wish to contract in that regard. On the other hand, it might be desirable to have bodies such as Mind or a voluntary service organisation as a LINK, the difficulty being that the relevant body might be a service provider of social care.
The Government have difficulty with the wording of the amendment. The phrase
“any organisation providing local care services”
is comprehensive. Bodies such as Age Concern might provide, for instance, meals on wheels services to a particular neighbourhood, yet be a minor provider of services in the area overall. Therefore, although the amendment has a valid purpose, we have difficulties with the definition.
Amendment No. 229 seeks to ensure that the chair of any organisation that provides local care services cannot become the leader of a LINK. Again, on the face of things, there is a potential conflict of interest in that situation. However, two arguments present themselves. The first is, I admit, a weaker argument, which concerns flexibility. In a certain area, the LINK might want to appoint a respected and knowledgeable individual who is the holder of a position with a local care service delivery organisation. The second argument is stronger. It is that conflicts of interest will be covered by the codes of conduct to which reference was made in the previous debate. In answer to my hon. Friend the Member for Bedford, I made the point that the principles of conduct in public life covered by the Nolan commission apply.

Andrew Stunell: Will the Minister acknowledge that the strength of the argument advanced by my hon. Friend the Member for Southport is that the presence of a person listed in subsection (4)(d) to (h) in the chair of the LINK might inhibit its capacity to look at a particular service area, even when an interest has been declared?

Phil Woolas: It may do; it may also do the opposite, because such a person would carry a great deal of weight. In line with the policy of being as least prescriptive as possible, we believe that the codes of conduct in public life are a better way of dealing with the issue of conflicts of interest. Obviously, local LINKs will take such matters into consideration when they are established.
Straying from my brief and referring to amendment No. 201, the Government want to enable independent providers to be hosts of LINKs, although we have a problem of definition regarding whether they should themselves be LINKs. Whether or not independent providers deliver care services, demonstrating to a local authority that they can manage any potential or perceived conflict of interests would be an issue dealt with in the contract. It is a matter of definition—an inevitable consequence of the fact that we are trying to introduce a broader regime and to join organisations. We want LINKs to be as free as possible to decide how they are governed, and we believe that the codes of conduct are a better way of addressing that than prescription in legislation. For those reasons, I resist amendments Nos. 228 and 229.

John Pugh: I thank the Minister for speaking to the amendments on their merits. I appreciate his dilemma, and I am grateful that he has been so frank and open minded about it. Clearly, there is a problem with a situation in which an independent provider also functions as an advocacy body, because one would not want such a body to have its feet under the table of a LINK. That is something that perhaps members of the Committee will want to take away and think about, because there is a problem of establishing a level playing field, and a need to exclude a BUPA hospital from effectively becoming a LINK.
 It has been entirely appropriate to point the Committee to the Nolan requirements, which have been used as an argument against previous amendments. However, the requirements work best when applied to relatively formal organisations that have an officer whose job it is to advise people when they step out of line. We are supposing that LINKs will be a relatively flexible arrangement in that there might not necessarily be a defined structure or an officer to offer the proper advice at the proper time. Therefore, while the Nolan requirements are a good answer in theory, we might get into all sorts of difficulties in practice.

Phil Woolas: The hon. Gentleman is probing right to the heart of the principles of the Bill, and I congratulate him on doing so. In the regime that the Bill proposes, the function of giving proper advice would be undertaken by the host organisation. Just as a monitoring officer or a section 151 officer in a local authority has a relationship with elected councillors, a host organisation would have a relationship with a LINK. That is common practice in this country, and I would argue that such relationships are well established. I think that that answers the hon. Gentleman’s point.

John Pugh: I am grateful to the Minister for that and will go away to reflect on it. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 154 ordered to stand part of the Bill.

Clause 155

Duties of services-providers to respond to local involvement networks

Alistair Burt: I beg to move amendment No. 202, in clause 155, page 111, line 2, at end insert—
‘(f) any other organisation contracted to provide care services.’.

Christopher Chope: With this it will be convenient to discuss the following amendments: No. 230, in clause 155, page 111, line 2, at end insert—
‘(f) any care provider commissioned to deliver local services.’.
No. 231, in clause 156, page 111, line 10, after first ‘a’, insert ‘locally funded’.
No. 232, in clause 156, page 112, line 10, at end insert—
‘(f) any care provider commissioned to deliver local services.’.
No. 204, in clause 156, page 112, line 10, at end insert—
‘(f) any other organisation contracted to provide care services.’.

Alistair Burt: We are in similar territory, so I shall not take too long. I am sure that colleagues on the Liberal Democrat Benches will do the same. The clause refers to the duties of services providers to respond to local involvement networks and defines under subsection (2) the services providers. The amendment would include within the definition
“any other organisation contracted to provide care services”.
Again, the definitions seem unduly narrow, bearing in mind the breadth of bodies and organisations that provide such care services. Hopefully, the amendment will be helpful to the Government in that it would widen the range of those who need to respond to local involvement networks. If they are included elsewhere, I should be grateful if the Minister helped us out. If they are not, our purpose is genuinely to open them up to the same scrutiny and duty to respond as any of the other defined providers.

John Pugh: Essentially, all the amendments are more or less on the same track, but this matter is possibly of greater significance and does not fall to some of the arguments that the Minister has presented so far.We are talking about private providers not in so far as they are advocates or anything else, but in so far asthey have a duty to respond. I suspect that the Government’s response will be that private providers are usually commissioned by a primary care trust or a public body and that, if LINKs have complaints, they ought to take them up at first base, which is the PCT that has the permission to service. That strikes me as a poor model of patient involvement.
 I wish to cite a couple of real examples. I have been involved in a debate in this place about the Cornwall out-of-hours service, which was presumably commissioned by the Cornwall PCT. When critics tried to find out problems about its performance, they found it extraordinarily difficult and had to resort to the Freedom of Information Act 2000 to get any valid information to assist them. The public were fairly confident that things were going wrong, but getting any real response from the provider organisation was the devil’s own job.
In similar circumstances, by and large the Merseyside PCTs commissioned a private provider. That provider has had difficulties. Identifying the difficulties has been very hard. In one case, a senior member of the private provider’s IT staff actually left, complaining that the service was delivered wholly inadequately, but was subject to a gagging order. When inquiries were made to the PCT about what was going wrong, we were told that it could not define exactly what was going wrong because certain things were commercially confidential, and that there were certain things that it, frankly, did not know about and had to find out. LINKs do not have the capacity to go directly to the private provider and say, “You are providing national health services. What is going on?” Worse still, without such an amendment, it will not have to respond at all. That is wholly inadequate. It should be able to respond, if only to say that it is working to its contract with the PCT, the PCT is satisfied, so ask the trust next. However, to have a situation in which our major services, such as out-of-hour services, can be delivered—

Alistair Burt: A patient’s journey through any part of the health process should be capable of being monitored. It should be the same process and as easy right the way through, notwithstanding the fact that the services may be provided by different groups of people. If it were made more complicated, that would get in the way of the patient involvement that we are so keen to provide.

John Pugh: Patients essentially want a response from the provider. The majority of people do not even understand what a PCT is, let alone how to approach it. They simply know that there are people delivering services. They know—or will know—that there is a LINKs organisation designed to find out why the service is not being delivered particularly well and they will expect a response from the service providers, not a remote response after the PCT has had a board meeting and discussed the issue.

Phil Woolas: I suspect that hon. Members on the Labour Benches in this Committee will agree with the sentiments that have been expressed by Opposition Members. In simple terms, should not the private and voluntary sector be subject to the same regime as the statutory sector if they are providing health and care services? That seems entirely reasonable. I want to explain how that point can be met by the legislation. We have a convincing argument—the hon. Member for Hazel Grove raises his eyebrows.
We have a similar problem to that which we had when we debated the statutory duty to co-operate. As a principle of policy, it is not desirable to impose statutory obligations on independent providers. Traditionally, it is not done in this country. It conflicts with the points being pushed by the hon. Members for Hazel Grove and for Southport. Having said that, we will ensure that independent providers of publicly funded health and social care comply with LINKs’ powers by ensuring that commissioners of the service include the requirement—in this case, the obligation for access—within the contracts, through the directions of the Secretary of State.
While it is consistent to say that it is not desirable to impose statutory duties directly upon providers, it is reasonable for the taxpayer to say that, if we are commissioning said organisation to provide health and social care services, as is the case under the clause, the contract into which it has voluntarily entered to provide those services, brings with it a responsibility to comply with the duties that are on the statutory sector. That is a perfectly reasonable policy to hold. It is in line with wider Government policy and it is the arrangement that is in place in relation to patients forum powers over health services.
There are some 28,000 contracts between the public sector commissioners and the private or independent providers of social care. It is not our intention, or that of the Committee, to force the renegotiation, mid-term, of those contracts because of the costs that that would entail and, more important perhaps, the disruption that there would be to patients’ services.
We accept that, in the short term, there will be differences between the public sector and the independent sector in relation to LINKs’ powers. However, we will require those powers to be included as new contracts come into place. In the meantime, any independent providers will be expected to be positive in their working relationships with the LINKs. That is our approach to the amendment.
To give further reassurance to the hon. Members who tabled the amendment, under which the definition of services providers would include any provider of services, including the independent sector, the clauses allow the definition of services provider to be extended by regulations, therefore allowing future flexibility to reflect changes in the organisation of the NHS, or other circumstances—what I refer to as the Bromley and Chislehurst point: we have to legislate for the unforeseen as well as for the foreseen.
Therefore, measures in the Bill meet the concerns outlined in the amendment tabled by the hon. Member for Southport, without taking what I argue is the undesirable step—and possibly one subject to challenge—of placing statutory duties on independent bodies. I hope that that satisfies hon. Members who tabled the amendments.

John Pugh: That is not exactly a champagne moment, but it is a significant clarification, because it achieves the same effect as the amendment by a different route. That is entirely laudable, but given that the Minister spoke about the private sector’s tendency to challenge a decision to lay statutory duties upon it, one hopes that we will not find further down the line that the private sector will find another cause for challenge under competitive tendering legislation. If it does not, I will be satisfied with his response.

Alistair Burt: The discussion has been quite thorough. I am content to withdraw the amendment at this stage. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 155 ordered to stand part of the Bill.

Clause 156

Services-providers’ duties to allow entry by local involvement networks

Patrick Hall: I beg to move amendment No. 219, in clause 156, page 111, line 9, leave out ‘may’ and insert ‘shall’.

Christopher Chope: With this it will be convenient to discuss the following amendments: No. 203, in clause 156, page 111, line 11, leave out ‘view’ and insert ‘inspect’.
No. 220, in clause 156, page 111, leave out lines 15to 19.
No. 221, in clause 156, page 111, leave out lines 22to 38.

Patrick Hall: Amendment No. 129 raises that old chestnut in the drafting of Bills: the difference in meaning between “shall” and “may”. It would substitute “shall” to require the Secretary of State to make regulations requiring providers to give access to LINKs for the weaker “may”, which implies that there is no such requirement.
 I turn to amendments Nos. 220 and 221. The clause will give the Secretary of State regulatory power to create the conditions that must be satisfied before the LINK can gain access for the purpose of observation. If the management of premises are not keen to allow access, the conditions listed in the clause—there are many of them—could be used to assist them in resisting or delaying LINK access. It could be rather bureaucratic and time consuming for a LINK to present a case for why it should have access and to have to overcome hurdles and so on before gaining agreement.
Furthermore, when in disputed cases it is agreed in principle that access can be granted, that access will be subject to limitations set out in regulations on the extent of a duty, whether generally or in a particular case, and provisions imposing or authorising the imposition of conditions and restrictions. Regulations might also limit the duty to allow entry to certain types of authorised representative, the number of authorised representatives and the hours during which a duty applies. Such regulations could be used to place hurdles in the way of LINKs trying to carry out their job.
I ask the Minister to consider, for example, the limitation on hours. It could be seen as entirely reasonable if used to limit access to within working hours, but it could also cause problems if a LINK comprising mainly volunteers, as LINKs will, wished to visit in the early morning or evening because some of its members might otherwise be at work. It is worth recalling that at present, under the 2003 regulations, patients forums enjoy a presumption in favour of inspection
“except where, in the opinion of those persons or bodies, this would compromise the effective provision of health services or patients’ safety, privacy or dignity”.
 There is a presumption in favour of access subject to those limitations, rather than a host of potential obstacles, of which I should be interested to hear some explanation. My amendments will not strike out subsection (2)(d), which refers to checks by the Criminal Records Bureau.
 I have also looked at the documents helpfully made available by Ministers last week and to which I have referred. One of the documents is labelled “Restricted—Policy”. It contains several pages on these matters and states that regulations will be preceded by consultation, which will seek views on a number of questions.
In responding to the debate, will my hon. Friend the Minister describe how the power to enter and view will apply to public sector organisations as well as to private and voluntary sector organisations, many thousands of which deal with social care and have thus far not had to agree to that kind of access?

David Burrowes: I shall speak to amendment No. 203 on inspection.
Definitions are very important in any Bill. As a lawyer, I take due note of definitions. I want to draw out the definition of inspection. The obvious place to look first, albeit not over lunch, is the “Oxford English Dictionary”—a dictionary for which I have great respect, not least because my wife, when she was ill, did the extraordinary thing of reading through it. That is not something that necessarily attracted me to her, but it has given her the upper hand in Scrabble and has given me due reverence for the book.
When looking up the definition of inspect, there is an important and significant point to bear in mind. We need to see whether that definition matches up with the Government’s intention as set out in their draft policy. In the Bill, the Government seek to put some flesh on the bones of their intention in relation to the duty merely to enter and view. It is important to see how that compares with what is a proper duty to inspect, which is, at the moment, a statutory duty relating to forums. The definition in the “Oxford English Dictionary”, as my wife would no doubt have told me if I had not looked it up myself, is
“to look carefully into; to view closely and critically; to examine (something) with a view to find out its character or condition”.
In that definition, to inspect plainly means more than to view. The important word is “critically”. To find out something’s character or condition requires a proactive step beyond viewing.
That is important because when one looks at the policy statement that was helpfully provided to the Committee, the intention referred to on page 2 is
“to enable LINKs to gather information about the services provided to local people. There will be times when it is right to see how those services are provided and to collect people’s experiences whilst they are currently using them.”
It goes on to state how important it is to observe the nature and quality of services. The concern is that that is only one stage. It is dealing with LINKs on the basis that they are gathering information and intelligence, but it does not take it any further. There is a recognition in that statement that LINKs make an important contribution to the process of service improvement, to supporting the work already undertaken by the regulators, and to incorporating the user perspective in their work.
The concern that has been expressed to me by the Barnet and Chase Farm Hospitals Forum as well as by others before the Committee is that the efforts to mainstream effectively the operation of LINKs in terms of entering and viewing does not properly deal with the true value of forums at present. The concern is that the aim is simply to incorporate their work within the regulators’ current work. I invite the Minister to give examples of where there has been duplication of work with the regulators that means that LINKs have to be effectively mainstreamed within the regulators’ own inspection regime.
 Why does the Minister not pay regard to best practice around the country, not least in areas such as Barnet and Chase Farm, where the forum has carried out proper inspections in the past months in anti-coagulation clinics, wards, catering services, accident and emergency, and patient phone services and is to follow that work in relation to blood testing facilities, stroke facilities, maternity and obstetrics, pharmaceutical and cancer services. They are all areas in which the statutory duty to inspect has been properly carried out by that forum among others, and it should be incorporated in the Bill.
The chairman and the secretary of my local forum say that the abolition of the right to inspect would be catastrophic, and that in some ways the
“spot inspections of cleanliness and patient management are far more effective than planned inspections by organisations such as the Healthcare Commission.”
The forum has a role, and it should not be absorbed by the existing regime of regulators and inspection.
 The draft policy statement goes on to say that LINKs will provide important intelligence to the regulators, which does not give due respect to the forums’ work. They are not simply intelligence gatherers for the regulators; they in their own right have a proper role of inspection on behalf of patients. That role should not be taken away or absorbed, but that will be the effect of not having “inspect” on the face of the Bill. Why is “inspect” not in the Bill? Is “The Oxford English Dictionary” definition incorporated in the Bill in terms of the LINKs’ role of entering and viewing? If not, their role should be expanded to include inspection.
On the inspection issue, I pay tribute not only to the OED, but to Jonathan Swift and “A Tale of a Tub”, which was:
“Written for the universal improvement of mankind.”
No doubt the Minister would like to pursue that goal. The critique was of a teacher who restricted his pupils’ exposure to knowledge, and there was a concern that prosperity would suffer if they were kept in ignorance. It is not necessarily the intention to restrict the LINKs’ pursuit knowledge or to keep them in ignorance, but we should give due regard to Swift’s words, in which it is resolved
“to keep you in an almost universal ignorance of our studies, which it is your inherent birth-right to inspect.”
Will the Minister reassure me his intention is not to keep the LINKs on behalf of patients in universal ignorance? The concern is that the Bill should at least include a power to inspect. It may not be an inherent birthright of LINKs or of patients, but because of the money that we pay in taxes and because of their value, the Bill should at least include the right to inspect. The policy statement does not leave me content or in a spirit of happiness. To draw on Swift again, however, his definition of happiness is
“a perpetual possession of being well deceived,”
so perhaps the Minister will make me happy.

Bob Neill: I shall follow on from the point that my hon. Friend the Member for Enfield, Southgate made about the particular value of spot checks. The point has been made to me, too, by people with whom I have spoken. I am concerned by pages 4 and 5 of the policy statement, which set out a significant diminution of the current rights of patients’ forums to enter and inspect, and to make spot checks.
The statement says that LINKs will only be able to enter and view, rather than inspect, and only with prior notice, rather than carry out spot checks. It then sets out a number of other savings and restrictions. The LINK will have to have
“written to the relevant regulator, indicating their intention to visit a facility, and received a reply”.
Page 5 states that a ground for exempting the LINK’s right to enter and view—never mind inspect—is that it has not given prior written notice. The proposed regime is far more restrictive than the current one, where the only restriction is on anything that would interfere with patient safety or well-being. What is the justification for that? On the face of it, the new regime will be much weaker in terms of involvement than the previous one.

Patrick Hall: Does the hon. Gentleman agree that it would be interesting to hear the Minister’s response to my point that what we have now is simply a presumption in favour, subject to some sensible limitations, and what is proposed would be less than a presumption? We would like to see the presumption continue, even if the words are slightly different.

Bob Neill: I am inclined to agree with the hon. Gentleman. However the language is dressed up, the thrust of the provision—the presumption—ought to be to facilitate inspection and to put the minimum number of obstacles in the way of it, consistent with safety and patient well-being. Many people involved in the patients forums are suspicious about whether the diminution of their right is yet another manifestation of the “get rid of the turbulent priest” scenario that I mentioned earlier.

Alistair Burt: I am pleased to support my hon. Friend the Member for Enfield, Southgate. We thank him for opening this debate by mentioning Jonathan Swift, whose name and character is always relevant to proceedings in the House of Commons, although even his great powers of satire would be stretched to cover the present Government. On occasions, he would have been forced to conclude as he retired and sheathed his pen that nobody could have made up what he had heard that day. As well as mentioning Jonathan Swift, my hon. Friend introduced us to the formidable Mrs. Burrowes. None of us will play Scrabble against her for money. We have all been well warned about the formidable lady and we will brush up our language when speaking to her.
 My hon. Friends the Members for Enfield, Southgate and for Bromley and Chislehurst have raised further serious concerns about the Bill and the unnecessary translation from forums to LINKs. I should like briefly to build on what they said. Definition is not the sole issue, although that is important—as are words. There has to be a reason why the term “inspect” has been removed from the legislation. That puzzles all the people whom we speak to in the forums. The subject came up when I met representatives from some 23 forums last month. My note says that
“Patient representatives need to be able to gain access to any facility where patients were being treated, and ask the necessary questions. Whether a power was defined as inspection, or audit, or something similar it was important that the NHS did not have the power, except in the most obvious and understandable circumstances, to exclude patient representatives.”
The fear that something has been done to them in relation to this change is held widely among those who have contacted us and submitted evidence.
Again, I turn to the published evidence submitted to the Health Committee, which has been dealing with this matter. Without spending too much time on this, it has not taken me long to find things relating to inspection. The Norfolk and Norwich University Hospital Forum says LINKs should have
“At least the same remit as PPI Forums to cover Social Care as well as Health. A critical friend plus statutory duties to monitor services and gather public opinion. With rights of inspection.”
The Royal Brompton PPI Forum says:
“LINks to retain right of inspection.”
Perhaps more telling, in evidence from Hounslow—[Interruption.] If the Committee will indulge me for a second, I seem to have lost that.

Patrick Hall: Have you lost Hounslow?

Phil Woolas: We lost Hounslow. [ Laughter. ]

Alistair Burt: I am not sure who would be most guilty of carelessness in losing Hounslow, but I wish that I could find the relevant papers.

Andrew Stunell: The hon. Gentleman is clearly in the midst of an important point, and I think that he deserves a slight recess to establish exactly which point he was making.

Alistair Burt: I am grateful for that intervention, because the short recess has refreshed me and has allowed me to find a key quote from Hounslow. The Hounslow Primary Care Trust, West Middlesex University Hospital, Ealing Hospital, Ealing Primary Care Trust, Hillingdon Primary Care Trust, Hillingdon Hospital And The West London Mental Health Trust PPI Forum says, in is submission:
 “If the new LINks do not have the power of access to premises providing NHS services, many Trusts will breathe a sigh of relief. Without regular monitoring/inspections the LINks will not have the information they need to help the Trusts to improve.”
The point about health trusts breathing a sigh of relief may be confirmed by evidence from the NHS Confederation, which represents the leaders and managers in the health service. They are not bothered about the power of inspection being lost—perhaps because that suits them. The Commission for Patient and Public Involvement in Health has some expertise in the area. In its submission, it says the following about the change in the inspection power:
 “This would replace PPI Forums’ existing power to inspect premises and it appears to be a more limited right than that currently enjoyed by PPI Forums, which gives them the power to inspect, for any purpose relevant to the Forum’s functions, premises owned or controlled by Strategic Health Authorities, PCTs, NHS Trusts, NHS Foundation Trusts, local health boards, local authorities, GPs and ophthalmic services.”
 So, forums themselves think that there is something suspicious about the change in the wording, and about the loss of the inspection power, and the CPPIH thinks the same, but the NHS Confederation, which represents managers, does not. As my hon. Friend the Member for Enfield, Southgate asked, “Why the change?” What is the distinction that is intended in removing the power of inspection? If it is intended to give forums exactly the same rights as before, why change the wording? If the concern is that the powers of inspection are too onerous on trusts, where is the evidence?
My hon. Friend the Member for Bromley and Chislehurst referred to the regulations, which mention spot checks. Of course, the more paraphernalia that must be gone through for an inspection, the easier it is to cover up anything that might be wrong. I am not suggesting that that kind of thing might occur deliberately. However, if one is looking for evidence of things that might have gone wrong and that might be affecting patients, there is good reason to bring out that evidence. Some of the cases on Clostridium difficile have been discovered as a result of spot checks by patient forums.
There should be a reason for the proposed change, but at the moment, I cannot see that the change suggests anything other than a step back from the sort of access and monitoring that we would like to see. There is general suspicion about it. If it is designed not to alter the powers of forums, it should not be made, and if the change is significant, the significance should be spelt out. At present, it looks like a diminution of powers—one that is unwelcome to those who know most about the matter, and to those who represent patients as opposed to managers.

John Pugh: I want to say a few words on inspection. The problem facing us is that we still do not know what LINKs will be, which makes it almost impossible to generalise about the powers that they should have, about the need for criminal record clearance, or about the issues that their visits to hospitals will raise. That seems to be the root of the problem.
I have some sympathy with the idea that we need a spot-check principle. Something like poor hospital food, or even whether patients eat the food that they are given, can be discovered only by spot check. If any advance notice is given, no food will be found lying for hours by the hospital bed.
We do not underestimate how complex a process inspection can be, so I understand to some extent why there is a debate and why it is not evident that one side is right and the other is wrong. Years ago, when as a student I worked in an old-fashioned mental hospital, I was familiar with hospital visitors trooping through with what was called a tour of inspection. The day that the tour of inspection took place was a day of absolute misery for the patients for whom we were supposed to be caring. They were swept aside while we cleaned every surface we could find and spread disinfectant around the place. The visitors were thoroughly satisfied that all was well, because everywhere looked spick and span. That is not an adequate inspection.
Inspection is a relatively complex process and needs to be done thoroughly and effectively. I would have thought that that would make a case for more consultation—I hate to make a case for more of it—with the hospitals that are inspected and the people who want to inspect. A regime can be established that is satisfactory to both, and if the Department of Health were to conduct such a consultation and publish the results, we could reach a conclusion with which everybody would be satisfied.

Phil Woolas: The answer to the last point is that that will take place.
The point that I want to get across to the Committee is that the powers proposed in clause 156 will allow the Secretary of State to impose a duty on the service providers, as we have discussed in respect of previous clauses, to allow authorised representatives of LINKs to enter, view and observe—I shall come back to the OED in a moment—the carrying on of activities on premises controlled by service providers. Those regulations, provided for in subsection (1) of, require two things. First, they require consultation. I find myself in the position in which Ministers often find themselves in such debates when members of the Committee ask, reasonably enough, to see the results of the consultation on the regulations. I am asking for a power for the Secretary of State to make regulations subject to that consultation, which will cover the point made by the hon. Member for Southport.
I can reassure the Committee that those regulations will be subject to the affirmative procedure, so the points that have been made in respect of the amendments can be made in respect of the regulations. It is reasonable to ask for powers to place some conditions and limitations on the duty—on the number of people who could conduct a visit at a particular time, for example, or the hours during which a visit can take place.
Hon. Members have made comments about health services, and hospitals in particular. We are talking about the full panoply of care services, and I see why there might be some scepticism given the fact that a visit could be undertaken only by an authorised person. To enable LINKs to gather information on all aspects of service provision, there are of course times when it will be appropriate to enter the premises and view the range and quality of the services provided. We therefore plan to provide LINKs with the power to enter health and social care premises, which will give them the opportunity to hear from people as they use the services. The inclusion of social care premises is a big step forward, as patient forums have the power to enter only health services. That is important to enable LINKs to gather the views of those who use the services, who often have little opportunity to make their voices heard.
The need for safeguards to be in place and for some services to be exempt is met for the protection of vulnerable people. For example, we do not think that it would be appropriate for LINKs to have powers to enter people’s homes, although social care services can be provided in people’s homes. I am sure that hon. Members would agree with that. My argument is that the bottle is half full, whereas the sceptics are arguing that it is half empty. I see their point, and suggest that regulation and consultation is the way forward. However, the powers to enter will help a LINK to form a view of the services by giving people in receipt of those services the opportunity to feed in their views.
Secondly, not all those involved in LINK activity will need to undertake that role. Those who are able to exercise the power must have the right skills, perhaps have the right training, be cleared by the Criminal Records Bureau, and be able to demonstrate an understanding of patient confidentiality and the right level of sensitivity. When the details have been finalised, we will specify which premises a LINK may enter and view. We will provide a new code of conduct on visiting to set out for LINKs, their hosts and the organisations that will be visited how the arrangements will work. LINKs will be expected to co-operate and to co-ordinate their activities with the regulator. We will ensure that that duty is in regulations, and we will consult widely.
I asked whether the “Oxford English Dictionary” provides a definition that the law recognises. The answer, as you might expect, Mr. Chope—I mean no disrespect to learned friends, and I will not be charging any guineas for this advice—is that a court must take into account the normal meaning of words.

David Burrowes: I can think of many a case in which I used the “Oxford English Dictionary” as a recognised authority on the ordinary meaning of words. Obviously, there may be different opinions about the ordinary meaning of words among our great populace, but it is a recognised authority on and source of ordinary meaning.

Phil Woolas: Courts must take account of normal meaning, and there is a difference between normal meaning and the “Oxford English Dictionary”. I learned some of the differences when I worked in the industrial world, but I shall not repeat those differences for the benefit of the Committee.
The serious point is that we believe that “inspect” carries the connotation of inspectors, such as the Healthcare Commission and the Commission for Social Care Inspection, and that “view” and “observe” carry the normal meaning and not the connotation of a formal inspection role. LINKs’ members are not inspectors or regulators as covered by the inspectorate regime. The hon. Member for North-East Bedfordshire is reaching for the “Oxford English Dictionary”.

Alistair Burt: If only. It is hard enough for me to find my place, let alone to consult the “Oxford English Dictionary”.
 The Minister has got to the heart of the matter, but what is the point, apart from changing the word? Is he declaring that there is no change whatever in the power that forums previously had to do their work when they entered premises and inspected? Can he guarantee to the Committee and every member of forums that nothing in the Bill will prevent them from doing anything that they previously did because the word “inspect” is not there, and that it has been changed only because someone might think that LINKs were inspectors?

Phil Woolas: The hon. Gentleman makes a fair point, and I shall choose my words carefully. The purpose of changing the word from “inspect” to “view” and “observe” is not to change any powers. That is not the intention. There is no restriction, limitation or curtailment of the powers of the patients forum in connection with the word “inspect” as opposed to the powers of LINKs in connection with the words “view” and “observe”. There is also no intention to omit powers. The difficulty for me in arguing the case is that the consultation on the regulation may result in some variation, but it is not the intention to change the meaning of the word “inspect” from that in the “Oxford English Dictionary”. I am trying to be as open as I can with the hon. Gentleman, but the hon. Member for Enfield, Southgate wishes to push me a little further.

David Burrowes: I hear the Minister saying that, in a sense, the clause is spurred on by concerns about connotations. That works both ways. The natural connotation of the words “enter and view” is passive. As applied to the activities of LINKs, the concern is that they will have a passive role of gaining intelligence, whereas the words “spot inspection” and “inspection” would denote a more active role. The connotations, to use the Minister’s phraseology, go against what the Minister is saying. He said that the existing roles will continue.

Phil Woolas: I am advised that there is no change in definition, but the hon. Gentleman makes a fair point. The counter-argument is that the connotation would be held by employees and potentially by patients themselves. People see “inspectors” and “visitors” in different ways. For the record, the Government’s intention is simply to avoid confusion with professional regulatory bodies such as the Healthcare Commission. The people who will be involved in LINKs are lay people, however much experience they have, which is why they are being asked to undertake the functions that we are discussing. As such, they will be able to take up the view of the patient and adopt a service-user perspective and feed that into a regulator’s assessments by, for example, informing the Healthcare Commission’s health check process.

Alistair Burt: I am grateful for the Minister’s concession—this is an important part of the Bill. What precisely is he saying has arisen because of the confusion about inspectors? Is he in some way saying that those who are being inspected are confused, and that that is a problem? Is he saying that the confusion is in the minds of members of forums because they are placed in an unfortunate position by being considered to be inspectors, and that they therefore cannot build appropriate relationships with trusts? Is he saying that it is more important to have inspections conducted by inspectors, and that what forums do is less important? The powers to visit, to see, and to be proactive—forums raise issues publicly and get things done, as my hon. Friend the Member for Enfield, Southgate said—are as important as anything that the Healthcare Commission or any other body has. What is the problem with a confusion over inspection? Why should such confusion cause a difficulty that the Government want to address? Where is the evidence that a problem has been caused by the issue of, and confusion about, definition?

Phil Woolas: I thank the hon. Gentleman. I had not expected such a forceful probing about the word “inspect” and the words “view and observe”. I take the common-sense view. The word “inspect” carries a connotation of professional inspection; the words “view and observe” do not, but that does not rule out the idea that viewers and observers can go to an establishment and be awkward so-and-sos. My personal view is that if I were a member of the public, I would sooner trust a group who have experience of holding hospital and care services to account in my local area, which can refer that to my council’s overview and scrutiny committee and get the local press coverage that would no doubt result. Such a group is a lot more powerful than a few suits coming up from London to stay in the Malmaison hotel for the weekend, which is what normally happens, although I am not decrying the professionalism of the inspectors in any way, or doing down the professional standards of Malmaison hotels.
The hon. Gentleman is reading too much into the Government’s intent. The change of wording from “inspect” to “view” clarifies the role of LINKs and is a more accurate description of what they do. To reassure him, the change will not represent a curtailment of the power of the patients forums.

Patrick Hall: May I just be clear? Is my hon. Friend saying that in practice, what patients forums do now is effectively to enter, view and observe rather than inspect, as we are now having a debate about those words? I should like clarity on his point that the Healthcare Commission’s inspectors are mainly lay people. I take it that we are talking about the extent and nature of people’s training to carry out the function either of inspection or of entering, viewing and observing.

Phil Woolas: On the point of definition, I can confirm that that is the case. Regarding lay people, I believe that I made the reference—I certainly intended to—in respect of LINKs rather than of professional bodies that inspect. That was the distinction that I was trying to draw.
I have covered the points made in amendmentsNos. 220 and 221 regarding access, but I have not covered amendment No. 219, tabled by my hon. Friend the Member for Bedford. He wishes to delete the word “may” in subsection (1) and insert the word “shall”. To be consistent and to back up my arguments about the other amendments, I must accept his amendment. To give the Secretary of State discretion over whether she or he makes regulations would negate the arguments that I have made to reassure hon. Members on the other amendments. Therefore, I propose to accept the amendment to give that reassurance.
As well as acknowledging the Committee’s role, accepting the amendment makes an important point. If one allowed circumstances in which the Secretary of State could not make regulations, the LINKs could not do their job as the Committee and the House have described it. I am assured by my advisers that I need not change line 1 of subsection (2), because if the Committee accepts my hon. Friend’s amendment, there shall be regulations. I urge Committee members to accept that amendment, reject the others and return to the points made about the regulations in consultation and debate.

Amendment agreed to.

Question proposed,That the clause, as amended, stand part of the Bill.

Andrew Stunell: I rise to ask the Minister to clarify how the measures will work in respect of tertiary health care. I do so in connection with an institution with which both he and I are familiar—the Christie hospital in south Manchester, which provides specialist cancer care for a large number of people in our area, right across Greater Manchester and beyond. A significant number of LINKs would be involved in monitoring what is going on there. At the moment, there is a separate specialist patient and public involvement in health forum covering the Christie hospital. Its work is valued by the hospital, and it is believed to be very effective in doing it.
Until now, we have been discussing primary and secondary care—district general hospitals and units that provide care for a comparatively restricted area, where co-ordination and co-operation across local authority boundaries is more or less trivial to achieve. However, in that particular case it seems that there would be a significant number of local authorities and LINKs. I have received representations from a member of the existing Christie forum, who is a constituent of mine, saying that there seems to be a real risk that the valuable work that is done in that specialist area of monitoring via the existing body could be lost. I wonder whether the Minister would give us some indication of how he sees the process working in those specialist circumstances, and what assurance can he give to my constituent who serves on the existing forum.

Phil Woolas: I was fearful then that just as the hon. Gentleman could not find Hounslow, I would not be able to find Christie’s, but I have located it in south Manchester. The hon. Gentleman’s point presents a similar challenge to that of my hon. Friend the Member for High Peak with regard to bodies that cover more than one area. His experience will be the same as mine: however much local people insist on having local services on their doorstep as far as certain types of health provision are concerned, when it comes to cancer and other related diseases, their first question will be, “How do I get to Christie’s?” It is an acknowledged world centre of excellence.
On the debate on the duty to co-operate, it is interesting to note the caveat that I expressed regarding some health trusts in relation to the example of Great Ormond Street. I asked the Committee to consider the danger that many local authorities throughout the country would try to enter into agreements with Great Ormond Street. That example, and that one only of all last week’s deliberations of the Committee, made it into the Local Government Chronicle. That rather shows the journalistic values of the LGC, but it also shows the seriousness with which people take these points.
The LINK for the area in which the tertiary health service exists will be able to enter, view and observe, and so on. We expect that other LINKs will enter into agreements with that body to provide a specialist way in which the tertiary service can be provided. As the hon. Member for Hazel Grove said, there are specific arrangements in place at the moment and because patients come to Christie’s from all around the country, not just our region, that seems a sensible arrangement.

Andrew Stunell: I appreciate what the Minister is saying, but to some extent he has drawn attention to what will be the real risk. If everything falls to the south Manchester LINK, or any Manchester LINK, not only will it have the job of managing or monitoring the primary and secondary health service in its area, but the specific job of managing Christie hospital, which draws on patients from a much wider area, as the Minister rightly says. The existing forum is made up of people drawn from the much wider area. The constituent to whom I referred was somebody who had an experience of treatment at the hospital, and who subsequently became a staunch friend of the hospital and a member of the forum. If we narrow the field from which a LINK might be drawn on a narrow geographical basis, it might lead to a considerable loss of expertise. Bearing in mind the point, which the Minister undertook before, that existing members of forums would have a route into the new system, he might like to consider how we might deal with what are perhaps not more than 20 or 30 specialist hospitals throughout the country, which are acknowledged centres of excellence, drawing from a very wide area.

Phil Woolas: I thank the hon. Gentleman for that intervention. I did not respond to the Jonathan Swift quotation, but I shall respond now by referring to Chairman Mao, who wisely said that the goat that belongs to everyone starves to death. In other words, if it is nobody’s job to do it, it does not get done. The hon. Gentleman is making an important point through the example of Christie’s, and my response to it is twofold. First, we were wise to resist amendmentNo. 198, which related to resources. Manchester city council would have to call on extra resources if it were asked to provide additional services in Christie’s, for example, through its host contract and its LINK. That would have to be reasonably taken into account. Secondly, the LINK for that area would be able to take on, under the flexible arrangements put forward, specific roles, functions and categories of membership to ensure that institutions such as Christie’s would be subject to proper scrutiny in this way and that a person from outside the area could be a member of that LINK.
Therefore we do envisage providing bespoke coverage for these very important bodies and institutions, but providing it through this framework means that it is somebody’s job to ensure that that happens. The danger in other examples—I appreciate the point the hon. Gentleman makes about the existing provision, with which I am familiar, as he would expect—is that they would fall between two stools. Therefore I agree with him and hope that he is satisfied by my response.

Tom Levitt: My hon. Friend’s answer is illuminating. I think that he has got the balance right. On one end of the scale, dozens of LINKs might want to make their own inspection of Christie hospital. At the other end of the scale, only the area in which the hospital stood would be able to have any input at all.
The hon. Gentleman has just spoken about people from outside a LINKs area being able to be on the LINK for that area. That is a way forward, as is the need—which I think I mentioned earlier—for LINKs to liaise with each other and for a mechanism to exist whereby a LINK that has a concern with Christie hospital is able to work closely with the LINK for that area to make sure that those concerns are taken forward.

Phil Woolas: I thank my hon. Friend and agree with him. That is indeed what we are trying to do. In practice, that will happen because of the cross-border relationships that exist. I have always wished that the world was divided neatly according to local authority boundaries, as that would make life more straightforward. However, he makes a fair point.
 I am conscious of Committee members’ concerns about the provisions in this clause, and that they will wish to see the regulations and the result of the consultation on those. I am also conscious of the paradox always faced by Ministers in asking for a power without the regulation: not being able to promote genuine consultation and yet be not too specific for Committee members. Therefore I hope that I have answered the points to their satisfaction, particularly in relation to the meaning and interchangeability of the words “inspect”, “view” and “observe”. On that basis, I ask for support for the clause.

Question put and agreed to.

Clause 156, as amended, ordered to stand part of the Bill.

Clause 157

Services-providers’ duties to allow entry by local involvement networks

Alistair Burt: I beg to move amendment No. 205, in clause 157, page 112, line 13, leave out ‘social’.
Briefly, the amendment is about definition. This clause makes reference to the ability of a LINK to refer a matter to the overview and scrutiny committee concerning social care services, but why not health care? Does the power to refer health care matters exist elsewhere? If it does, I should be grateful if the Minister would provide details of that. If it does not, the amendment proposes putting it in the Bill. If the Minister will help us out by telling us where we might see such an equivalent power, the amendment will have served its purpose.

Phil Woolas: Well spotted and well predicted. The hon. Gentleman has spotted what appears to be a gap in the Bill but has predicted that there is an answer to that. He is right. For the Committee’s information, there is an existing regulation-making power in section 7(3) of the Health and Social Care Act 2001, which can be used and is used to prescribe that overview and scrutiny committees respond to LINKs on health service matters. Again, that shows the joined-up nature of Government policy—all Labour Members were aware of that provision. However, other hon. Members will know that, in practice, overview and scrutiny committees already take up the power. That is the answer to the hon. Gentleman’s successful spotting of an apparent gap.

Alistair Burt: The Minister’s masterful flexibility never ceases to enlighten the Committee. One moment he quotes Chairman Mao; the next, he professes his support for private health—and presumably for Trident. The flexibility of the modern Labour party causes us much distress, because we remember the time when he and all his colleagues carried the little red book. We knew where we were with socialism in those days—it has become a lot more complicated now.
There is no actual flexibility in the present case. The Minister is saying that the same power exists in other regulations, such that LINKs have the power to refer health matters to an overview and scrutiny committee, which is what we wanted to find out. We appreciatethe response. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 157 ordered to stand part of the Bill.

Clause 158 ordered to stand part of the Bill.

Clause 159

Sections 153 to 158: interpretation and supplementary

Amendment made: No. 135, in clause 159, page 114, line 33, leave out from ‘council’ to ‘county’ in line 34 and insert
‘in England, other than a council for a district in a county for which there is a’.—[Mr. Woolas.]

Clause 159, as amended, ordered to stand part of the Bill.

Clause 160

abolition of functions of Patients’ Forums

Question proposed, That the clause stand part of the Bill.

Christopher Chope: With this it will be convenient to discuss amendment No. 181, in clause 175, page 124, line 37, at end insert—
‘( ) Sections 160, 161 and 162 shall not come into force until the Secretary of State is satisfied that a local involvement network is in place and is functioning in each local authority area.’.

Alistair Burt: I intend to vote against not only the amendment but the clause. I gave the Minister and the Whip notice of that well disguised ambush this morning, so I can scarcely be accused of being a troublemaker.
The clause relates to abolition of the functions of patients forums. I shall oppose it on behalf of all those who submitted information about the forums to the Health Committee and to this Committee, together with all those who appeared as witnesses and all who have been speaking to me and my colleagues about the issue. I do not think that we have had an adequate explanation of why patients forums are being abolished. I do not think that anything is being added to patient rights by removing the forums, nor do I think that anything is being added through what is being included in LINKs. For the reasons that I have already stated in relation to previous amendments, I believe that the powers of patients will be diluted.
I appreciate everything that the Minister has explained on the background to Government policy. However, despite the words and the intention, experience demonstrates that good intentions can often turn out in practice to be another tightening of the centralist screw that keeps control where it needs it, and makes it more difficult to hear the voice of the patient and of the ordinary citizen. We still do not really know what LINKs will be. We are pretty sure that they will not be virtual entities, although we cannot be certain. It will be left to local discretion and we do not quite know what LINKs will look like. We do not know how many people will be on the LINKs. We do not know whether LINKs will be small enough to be manageable, effective and do their job or large enough to include everyone who wants to be part, but who will therefore be rendered ineffective because of that. We do not know whether there will be sufficient money for the training of all those people, not least those who will have the ability to look at premises and inspect, monitor or audit them. However, they must be capable of doing their job, and if there are large numbers of new people, where on earth is the suggestion coming from that there will be enough funding to train them?
We do not know whether LINKs will be an authentic patient voice or drowned out by the other people who will now be encouraged and urged to join them to dilute that voice. We do not know whether the expertise of members of forums will be retained. People have already complained about being messed about by constant change. We do not know whether they will hang on in there and bring their expertise. They will not be invited to transfer automatically into LINKs should they wish, so we do not know whether that core of expertise will be retained. Despite best intentions and discussion of precisely what they will be allowed to do, we still do not quite know. Will the power of inspection indeed mean exactly what it says or has it been changed subtly to the advantage of managers and to the detriment of patients? We are concerned because we have not received an explanation.
I turn again to the evidence that was provided to the Select Committee. Leicestershire and Rutland PPI forum said:
“We fail to see why PPI Forums should be abolished rather than being enabled and encouraged to evolve in partnership with the voluntary sector. Such disruption is very disheartening to the volunteers who have invested considerable time and effort into the PPI Forums.”
Asked by the Select Committee gathering evidence,
“Why are the existing systems for PPI being reformed?”
Norfolk and Norwich University Hospital PPI replied:
“A very good question, because Forums, after a great deal of hard work, are already monitoring their areas and gathering public opinion; plus building relationships across the voluntary sector.”
I have now at last reached north Oxford. The Northern Group of Oxfordshire PCT PPI Forum was asked by the Select Committee,
“Why are PPI Forums being reformed after three years?”
to which it replied:
“The DoH has offered very little information about what they think has gone wrong with Forums, however it was the DoH which killed off the Community Health Councils and we wonder if the same kind of chop and change policy is being repeated for the sake of being seen to be doing something—anything!”
The Oxford and Bucks Area of South Central Ambulance Service PPI Forum said simply:
“It is outrageous that PPI Forums should be abolished after only two years and that the Government has been aided/abetted in this by collusion with the ‘Panel of Experts’.”
At this stage, we now put our broad concern to the Government. Widening the involvement of bodies and parties in the process of monitoring and scrutinising the health service is well intentioned, but there is a danger of losing baby with the bathwater. I do not think that any of us have had presented to us—and in all fairness, I do not think that the Minister sought to present to us—the fact that anything had gone drastically wrong with the forums. There were no criticisms of their work; no evidence was presented of how they had fallen down on their job; there was no evidence of the system being disrupted by the activities of forums; and there was no suggestion that individual troublemakers were causing difficulties for those who managed and worked in the trusts or the staff who work so hard in the health service. There was no evidence of any problems with the forum. What we see here once again is the desire to meddle and the desire to change, coupled with the sense that something is being taken away and that the power of the centre is being strengthened.
For that reason, and because those who work so hard in the forums feel so angry and upset about what has happened—but, no doubt, if the Bill is passed and the measure goes through, will commit themselves to serving the health service and patients wherever they may be, and will probably stick with it—we say on their behalf that we do not think that the forums should be abolished at all. It would have been better to take the route of reform and evolution.
We oppose clause 160. We will not vote on clause 161, although we could have done so, because it has the same effect, but we are putting down a marker. We do not think that patients forums should be abolished, and we do not think that a case has been made for doing so.

John Pugh: This is the latest in a series of abolitions. Community health councils have been abolished, and forums are now being abolished and replaced by LINKs. All those organisations have certain things in common: they are all essentially consultative organisations. They differ in structure, membership and influence. They are all affected by the changes. The constant change affects their ability to function and be effective. There is also a loss of institutional memory. However, to be fair, none of them is a decision maker. The decision makers in the health service are invariably the quangos. I turned to my community health council when the children’s A AND E moved out of my town. It agreed with much of what I said but was powerless to prevent the move.
Later on, consultants suggested that the adult A AND E move out of town. I turned to the patients forums and they backed me wholeheartedly. Although I was grateful for their backing, the decisive factor was a change of mind by the trust, which had as much to do with finance as it did with the delivery of services.
Looking at things in the round, the proposals are endeavouring to address a genuine democratic deficit. One would have thought that the democratic deficit would easily have been solved by making the quangos themselves accountable to local people or having local people or locally elected people make the decisions.
The Government seem to take the view that health decisions, or decisions about health services, are best made by the experts. They suppose that the people on the quangos are experts. Things being done another way appears to them to lead to madness, chaos, populism, liberal democracy or whatever. The Government basically have that rooted view.
 However, there is a clever new argument that the Minister has presented in the course of these deliberations, which has also been presented by other Ministers, and that is to distinguish between participative and representative democracy. The former is a democracy in which people do not actually decide. They just in some way participate. They get consulted and informed. That is obviously better than not being consulted and not being informed, and obviously good consultation is better than poor consultation. What we are arguing about here is simply models of consultation. I accept that consultation by itself is a type of restraint. Consultation that is coupled with a power of further reference is a further restraint, but it falls a long way short of what I would like to see, which is democratic accountability. However, the Government clearly do not envisage that happening in the immediate future. All that we appear to be doing here is making a few timid steps in that direction. None the less, I am grateful for that because over the past few years, things have been moving in the opposite direction.
I cannot predict how LINKs will grow and flourish. I would not like to lay bets on what we will be saying about them in years to come. However, it is a risk to change things. There is always a risk in doing that and one always assumes that in taking the risk there must be some prima facie case that the Government are looking at that says previous arrangements have not worked as well as expected, or not done the job intended.
The Government are not saying that the patients forums have not taken the quangos to task in a sufficiently robust manner. If that was their rationale and they thought that they had a better way of doing that, I would warm to their proposals. If that is not their reason, they must have another one. The fact that they have another reason renders me fairly suspicious of their intentions and supportive of what is being moved.

Patrick Hall: I should like to speak to amendment No. 181. Before doing so, may I just say that I would not want the further champagne moment on amendment No. 219 to be allowed to pass unnoticed. I am surprised that the hon. Member for North-East Bedfordshire forgot to mention it. Amendment No. 181 is designed to provide a proper transition between PPI forums and LINKs, so the position is not the same as that which the Conservatives have taken. If LINKs come about, we will have to deal with how we go from where we are now to where we want to be. My understanding is that the Bill will be enacted by the end of this year—assuming that it achieves Royal Assent, that is—and that patients forums and the commission will be abolished, say on31 December this year, with LINKs coming into force the day after. Whenever that happens, there will have to be a means of dealing with the changeover as cost-effectively and smoothly as possible.

Alistair Burt: I am grateful to the hon. Gentleman for giving way because, first, he has given me an opportunity to acknowledge his genuine champagne moment in achieving an amendment. We should accept it, because we know that he will be generous with the champagne on being successful. Secondly, on his point about transition, he will remember the long-drawn-out demise of the CHCs and the difficulties in staffing, contracts and everything else. He will want to make the point to the Minister that surely we do not want to go through that again.

Patrick Hall: I do not need to make that point, which I was going to make, because the hon. Gentleman has just made it for me, which is absolutely fine. If LINKs come about, I am sure that the hon. Gentleman and others from all parts of the House will want the system to grow and to start as strongly as possible.
The new duty on local councils to contract for LINKs will come into force at the right time after the abolition of the forums, but that is not the same as LINKs being in place and fully functioning on the day after forums cease to exist. It is important that we consider such matters, because if there is a hiatus, or confusion and gaps of one kind or another up and down the country, we will miss out on the opportunity to get the public involved in something that many may wish to do, including those who are not the sort to have been involved in committees in the past and might not have been on CHCs or patients forums.
We might also miss the opportunity to have as many members of patients forums as possible joining LINKs. The Minister of State, Department of Health, my right hon. Friend the Member for Doncaster, Central(Ms Winterton), has gone out of her way to say again and again that there would be nothing better than for all members of patients forums to become members of LINKs. LINKs would involve many more people than just those people; none the less, they would form an important basis of stability for the new LINKs. However, if we do not have a proper transitional arrangement, some of those people will disappear and opportunities will be lost.
The concept of LINKs, in the way that the Government have presented it, is highly ambitious. We have never tried anything like it before. It is easier to think in terms of the committee—we are all used to committees. Local government wants to have the new responsibility and welcomes it. That is welcome, but we saw in our evidence sessions that although the leaders of local government whom we questioned very much supported the principle of LINKs, they had not had the time to go into the detail, which I fully understand. I suspect, therefore, that the level of awareness throughout the country of what will be needed, in setting up hosts and so on, will be variable to say the least.
Bedfordshire is already quite well advanced on that, however. I recently met two members of staff from Bedfordshire county council whose job it is, or will be, to concentrate entirely on helping to deliver the links of the LINK in Bedfordshire. However, that will not be the case everywhere and there will be variable states of readiness. Once the legislation is in place, we will need to wait for further regulations and guidance. Consultation on some of those documents will be needed, which is welcome. Budgets will need to be in place. Advertisements will need to be published to attract potential host organisations, and discussions and negotiations will be needed with host organisations about what is needed in particular parts of the country. That will all take time.
We all want the process to take whatever time is necessary. We hope that it will not drag on for too long, but it needs to be done properly if it is to be done at all. I will need some persuading to believe that it will take place by 1 January next year. Some comments from my hon. Friend the Minister on that point would be welcome. If that should prove to be the case and it should be obvious by 1 September that the delivery will not take place throughout the country, I hope that my hon. Friend will be able to show willingness and open-mindedness towards delaying the abolition and so on of the forums and the commission by three or six months to ensure that the new system, when it starts, works as fully as can be expected and, to use a phrase that is used increasingly in government and elsewhere, that there is a seamless transition and service.

Philip Dunne: I rise to support the amendment of my hon. Friend the Member for North-East Bedfordshire and to probe the Minister on one or two aspects of the intent behind his determination to abolish a body that was set up by the Government only three or so years ago—

Phil Woolas: Five.

Philip Dunne: I believe that it came into effect in December 2003. Why did the Government not learn the lessons from setting up the patients forums in whichever year that took place? We must remember that everyone who sits on a forum does so voluntarily, and 4,500 people around the country have developed expertise and experience in similar things to what the LINKs will be expected to do. It seems most perverse not to take advantage of that experience. My understanding is that when the CHCs were abolished members were allowed to become members of the forums. They were not encouraged; it was not an automatic process, and as a result the development was haphazard. Some joined, some did not.
If we must have LINKs, why not base them on the forums? Instead of transferring the assets of the forums back to the Department of Health, the assets and personnel should form the core of the new LINK. That would seem a logical progression, and a perfectly sensible and joined-up thing to do. The Government could benefit from the individuals’ expertise. If some did not want to participate as a member of a LINK, fine. They could look for other people to take on that role. I have yet to hear a single argument from a Government Member about why it is appropriate to proceed in the way that they propose.
Let me pick up on the point made by the hon. Member for Bedford about transition arrangements. He mentioned what is happening in Bedfordshire country council, and he will not be surprised that Shropshire needs to get a look in. Shropshire has thought ahead—because the provisions in the Bill do little to help determine how the LINKs will be established—and will convert the forum into a LINK. The county council has set up a body whose title does not easily trip off the tongue: it is called the Shropshire PPI self-adopter committee. The chairman of the Shropshire County primary care trust PPI forum has been appointed as a facilitator, effectively to step into that role and to start to work with interested bodies on how the LINK should be formed. That is clearly a sensible model. The Minister might say that that is what should happen around the country. I hope that he will, because it will show that Shropshire, as usual, is ahead of the Government and ahead of the game—well, for the purposes of this Committee, it shares that honour with Bedfordshire. If he does not say that, he must explain what he expects the existing forums to do. I hope that he will take this opportunity to do so.

Tom Levitt: I begin by echoing a few points that I made earlier. First, I do not think that there is anyone in the room who does not regret having had to go through two reorganisations in such a short space of time. Obviously, it would have been better if we had not had to do so. Secondly, “abolition” is a very emotive word, but it is also a technical term that is necessary to the Bill. If clauses 160 to 162 were called “Seamless merger of patients forums etc.”, I am sure that there would not be any such problem.

Andrew Stunell: Does the hon. Gentleman recognise that “execution” is also a technical word—with a very specific meaning?

Tom Levitt: It has several specific meanings. The hon. Gentleman executed his intervention very well indeed. Just as an aside, I recall that 10 years ago almost to the day, the hon. Gentleman and I—the Tories did not turn up—were debating health policy at Stepping Hill hospital. One question was, “Could you explain the fundamental difference between the health policies of your two parties?” The hon. Gentleman expounded Liberal policy at great length, and when it was my turn to reply, I said, “The difference is that we will put ours into practice,” which we are and have been doing successfully.
Everyone accepts that there were some very good community health councils, but that equally there were others that we did not hear of, and others still that we would rather not have heard of, because they did not do their job as well as others. I do not know the forums’ movements quite so well, but I hazard a guess that the same is true now.
Indeed, the hon. Member for Ludlow just reminded us that there are 4,500 forum members in the country, which averages out at seven people per constituency. I know only one member in my constituency, although that may be my fault, because there may well be more. However, an average of seven people per constituency does not represent a huge level of public involvement.

Alistair Burt: I am following the hon. Gentleman’s argument closely. If, as part of a national body, a number of organisations are under-performing, is not the right answer reform, rather than abolition of the whole lot?

Tom Levitt: The hon. Gentleman is right. I am about to spell out why the need for that reform—at the moment—is fundamental. Indeed, there are opportunities for reform which did not previously exist. There are three reasons why there must be reform now. First, to stop the trichotomy between the good, the not so good and the best, the LINKs or the patient involvement forums—whatever form the bodies take—must be subject to scrutiny and oversight. The Bill links that—with a small “l”—to the local authority process of scrutiny, which only three or four years ago was still in its infancy. There is now in local authorities a more mature system of scrutinising what happens not only in the local authority world, but in the public sector generally.
Secondly, we must expand the sphere of influence and take in care, which means examining how the voluntary and private sectors provide care. That in turn would involve legal changes to the patient involvement process. Thirdly, there is now a huge grey area between local authorities and health bodies and their responsibilities for promoting public health. Barriers have been imposed on what forums can scrutinise and examine, and it is necessary to break them down. Those are three reasons why we can improve on what we have now, and we must move forward.
Throughout the Bill, but particularly during the few hours in which we have discussed part 11, I have been impressed with the way in which the Opposition, and the hon. Member for North-East Bedfordshire in particular, have taken such a constructive view and engaged with the Bill. However, by voting against any one of the three clauses, he would be suggesting that we should have LINKs as well as the forums. That would be the consequence of voting against any of the clauses, unless, of course, he votes down the whole Bill. I think that he would agree that if we did not have a patient involvement process at the moment, he would be hard pushed to fault the proposal for LINKs. Only the fact that we are moving from one process to another is causing disruption.
I refer the Committee to our earlier proceedings when I put the point about abolition to the Minister of State, Department of Health, my right hon. Friend the Member for Doncaster, Central. She replied:
 “We need a strong body that is able to scrutinise decisions and increase patient and public involvement rather than organisations that are, in a sense, tied to institutions, as patients forums are. We want the members of the forums to be involved in the new LINKs.”——[Official Report, Local Government and Public Involvement in Health Public Bill Committee, February 2007; c. 110.]
There are only a small number of forums, and quite frankly, in many parts of the country, they do not have a high public profile. Furthermore, they are not linked to the democratic process and to democratic accountability—points made by the hon. Member for Southport. Those concerns must be addressed. We have a local authority scrutiny process, which was not available before, but into which we can tie the new proposals. I hope that we can get over the emotional response to the word “abolition”, and move on in order to build a better process, seamlessly, on new year’s day.

Phil Woolas: I thank hon. Members for the debate so far. It occurs to me that when the Government propose the abolition of a quango, we are accused of getting rid of accountability. When the Conservative party proposes the abolition of regional assemblies, which would hand power back to Whitehall, it puts forward its argument for greater democracy and accountability.

Alistair Burt: The Minister admits much.

Phil Woolas: I admit much, but I am consistent on that point. I suspect that the hon. Gentleman knows that.
The hon. Gentleman makes a strong case. He asks the questions that it is the duty of the Opposition to ask: are we making change for change’s sake, and, if we can convince the Committee that it is worth it, will the change be made in a way that is beneficial? Those are his two fundamental questions. He asked the first not just from the point of view of the Opposition, but from that of Conservative policy, with which he is consistent. He is quite right to ask those two questions and it behoves me to persuade the Committee that the case for change is strong and not to repeat the arguments made by my hon. Friend the Member for High Peak, in order not to duplicate comments.
It has been five years since the legislation that established patients forums came into effect. It was taken through Parliament in 2001-02. Evidently, there has been significant change in health and social care provision during those five years. The Government believe that the arrangements are needed to support a stronger voice for users and citizens and to keep pace with that change, and that a system based on the scrutiny of individual institutions is no longer appropriate. We want the new system to be able to consider both health and social care so that arrangements to promote and amplify the voice of users and the public can be joined up across the entire system.
The hon. Member for North-East Bedfordshire raised the fear that the focused voice of patients could be swamped if the Government are successful in their goal of widening participation. On the contrary, such a strengthened body, involving a swath of voluntary organisations, and support, patients and carers groups, and so on will in fact strengthen the umbrella body of the LINKs and give greater weight and authority to the focused voice of patients, in particular owing to a more widespread and professional approach.
As my hon. Friend the Member for High Peak hinted, there is a patients forum for every NHS trust, foundation trust and primary care trust in England. Each forum has on average eight members who, although I do not criticise their work at all, clearly do not represent all the people in the areas covered by their trusts. Forum members tend to speak about their own concerns—that is understandable; it is what we have asked them to do—rather than about those of the wider community. Membership of forums is formalised through a process that tends to be exclusive. I recognise that that was wrongly anticipated in the legislation. Thus they attract only a narrow section of the population. The LINKs, by contrast, are intended to seek the participation of a wider group of people, including members of voluntary and community sector organisations and individuals from each local area, and do not involve a formal appointment process.
The proposed changes are necessitated by the significant changes that are taking place in the health and social care system—for example, the changing configuration of primary care trusts; the changing role of PCTs in relation to the commissioner of services; and the move towards the joining together of PCTs and social services, which is a key aspect not just of better provision of services but of covering the health and social care of our population in an efficient and affordable way. The movement that has occurred in Herefordshire, where the PCT and the social services are joining together in a single trust, is of enormous importance. Notwithstanding that example, the local area agreement process and the other measures in the Bill are bringing together the partners in this sector. In order to reflect those changes, we need an accountability framework as well as the performance framework that we have already debated.
We are also moving towards greater choice in service delivery. There is a more comprehensive range of means of delivery, and quite right too. The edges between the statutory sector and the private independent sector are becoming blurred, to the benefit of patients and citizens more widely. Finally, on this point, the increased joint commissioning across health and social care is important.
Opposition Members and colleagues on my side of the Committee would be right to ask, “Where have these changes come from? Are they a bolt from the blue?” It is possible to follow the development of policy over the past seven to eight years, including at the time when the patient forums were being introduced. Hon. Members may have seen House of Commons Library research paper 07/01 on the Bill. The Library should be commended for the excellent way in which it presents such information for our benefit. That document points out on page 92:
“On 22 July 2004 the Government published the report of a review into NHS ‘arm’s length’ bodies. John Reid, then Secretary of State for Health, announced that the number of such bodies would be reduced, saving at least £500 million—”
that is from a Government who are accused of establishing quangos; the reality, in that area as in all areas, is the opposite—
“and increasing resources that could be channelled directly to frontline NHS patient care. One of the ‘arm’s length’ bodies affected was the Commission for Patient and Public Involvement in Health, which would be abolished.”
We will come on to that when we consider clause 162. The document continues:
“The review document said...Stronger more efficient arrangements to provide administrative support and advice to Forums will be put in place.”
That was written in July 2004.
 The research paper points out that the Commission for Patient and Public Involvement in Health, which was involved in the review, took part in the review of patient and public involvement that followed the 2004 report. Extracts from the overview paper that it submitted to the expert panel set up by the Government early in 2006 are reproduced in the report. I advise the Committee to look to the words of the commission:
“The Commission argued that it was not feasible to continue with the current system and instead recommended a system of local networks.”
Its description of the failings of the current system included
“the high levels of frustration within the system caused by discordance between vision in legislation and implementation”.
 That may be a fault of legislation as well as of implementation, I admit, but it is real nevertheless. Secondly, it states that the Department of Health emphasises that
“the service improvement function, monitoring and review of services is too often the sole pre-occupations of Forums.”
Thirdly, it says:
“Too much has been expected of too few people. It is unrealistic to expect volunteers, however committed, to do all the things that are expected of Forums to improve all of the NHS services in their area, as well as to engage the wider community in holding the NHS to account.”
It then deals with other problems, not criticisms of the activities of the individual, and it recommends the setting up of networks similar in concept to those that we are debating now.
The force majeur for change is to be found in the evidence of what is happening on the ground. It is a result of the changes that are taking place. It is not reform for reform’s sake. It is creating a framework of accountability to supplement the other changes proposed under the Bill within the framework of sustainable community strategies, the statutory duty to co-operate on partner organisations and local area agreements. One of the four main funding streams is meant to join health and social care in order to provide services to suit the individual rather than the service provider. I believe that the case for change is strong.
Amendment No. 181, tabled by my hon. Friend the Member for Bedford, deals with my hon. Friend’s concern that organisations should not fall between two stools. My contention is that all patient forums as well as the commission should remain functional until all links have been established. If only one local authority were slow to establish a link for its area, every other area would have to run the two systems in parallel. Not only would that be impractical, but it could be hugely expensive. To meet the hon. Gentleman’s second point, my hon. Friend is keen to ensure that change is done in a way that will lead to improvement. He is right to point out that the Government should not and cannot be hasty in implementing those changes.
 There is no commencement date on the measures before the Committee, but we envisage that it will be in the spring of 2008. Many of the measures that have been put forward in the Bill ensure that new frameworks are in place for April 2008. That is the beginning of the three-year spending period within which we intend to provide stability for the funding of public services. It explains why we are going through what we are going through in terms of PCTs’ historic deficits. It explains why we are creating the new accountability framework. It explains why, in my answer to the hon. Gentleman about the commencement date of the new performance risk management, I said that 2008 would be a desirable date. That puts into the jigsaw that crucial piece required to ensure service improvement in a devolved era—namely, allowing participation by a wide group of patients and potential patients in the improvement of services.

Patrick Hall: I find my hon. Friend’s remarks very helpful. When he referred to spring, I presume that he meant that the new system would be under way by April 2008. That gives us a bit more time. However, in order to prepare, money will need to be spent up front. Will he address that point in order to give us further reassurance?

Phil Woolas: I think that I can give that reassurance through the general powers of local authorities—they will be watching the progress of the Bill closely—and the money that will be made available through the new burdens procedure, because that procedure and the agreements with Her Majesty’s Treasury concerning in-year spending apply. It is obviously desirable that commencement dates coincide, when possible, with financial years. For some reason, the financial year in this country runs from April to the following March. I have never understood why, but it is probably something to do with accountants’ holidays. We have criticised lawyers, but let us not go on to accountants.
 I hope that I have convinced the Committee that the case for change is strong. I also hope that hon. Members are convinced that that will provide the direction of travel, which they say they want and which we want, towards more devolution and decentralisation. I ask the Committee to resist the opposition to the clause.

Alistair Burt: I appreciate the Minister’s comments, and I shall not bat each and every one back to him. The Library’s very good research paper enables me again to quote the then Minister, Melanie Johnson, on page 91. When the Government announced in July 2004 that the Commission for Patient and Public Involvement in Health would be abolished, she made it clear in relation to the forums:
“They will not be abolished, nor will their independence be undermined.”
That commitment has obviously been broken.
Secondly, I draw attention to the fact that we have forced from the Minister the tough expression that effectively the patient forums are the wrong people to do their job. They are being blamed for the fact that although they volunteered, others did not, and that is why they are seen to be exclusive.

Tom Levitt: Will the hon. Gentleman give way?

Alistair Burt: No, I will make my point. I hear what the Minister says, and I know that it comes from the commission review—that is my third point—which is again a top-down analysis of what is wrong. That contrasts with the evidence given by forums to the Select Committee. It is a difficult point. I know that the Minister is not criticising the individual members of the forums—no one here has done that—but somehow, because they do not institutionally represent a wide enough group of people, that seems to be their fault, and yet another attempt is being made to broaden, deepen and widen. That attempt was made when the forums were set up after abolition of CHCs in 2000. What will happen if the right people do not come forward to provide the base material for the LINKs? Will they too be scrapped?
The feeling is left that those who constituted CHCs and the forums have, despite their best efforts, not quite performed institutionally as the Government wanted, so they are digging them up and starting again. How many times will that be done? A line should be drawn in the sand on their behalf to say, “Enough”. We take the Minister’s point, but we do not agree. There is a question mark over the process that has left so many people at grass roots level dissatisfied. Accordingly, I move that the clause does not stand part of the Bill.

Question put, That the clause stand part of the Bill:—

The Committee divided: Ayes 11, Noes 8.

Question accordingly agreed to.

Clause 160 ordered to stand part of the Bill.

Clause 161 ordered to stand part of the Bill.

Clause 162

Abolition of Commission for Patient and Public Involvement in Health

Question proposed, That the clause stand part ofthe Bill.

Patrick Hall: We are now considering the abolition of the Commission for Patient and Public Involvement in Health. The word “abolition” is in the Bill and has definite meaning. However, it would be wrong to pass this clause without making one or two remarks about the commission, which, despite living under a sentence of execution for a long time, has continued to do what it was asked to do by the Government when it was first set up. It has helped patients’ forums to carry out a number of important tasks, which I mentioned earlier. Those tasks have a wider dimension than what is going on in a particular locality. I am referring to such things as national surveys on the use of telephones in hospitals and the quality of food in hospitals, and the current survey on personal dignity in hospital wards. It is unlikely that those things would have been done had they been left to individual forums. That goes back to the point that I made about the need for a national dimension to be organised.
I understand what the clause is about, but we should not let it pass without at least acknowledging that the commission has done what it was asked to do and has continued to do that in what have been conditions of uncertainty for some time now. We should thank the staff of the commission for sticking to the job that they were asked to do. Judging by what my hon. Friend the Minister said, abolition will take place possibly in March or April next year. I am sure that between now and then the staff will be professional enough to continue to carry out their task as they have done thus far.

Phil Woolas: A previous clause—clause 160—related to the functions of patients forums, and the next clause, clause 161, related to the patients forums themselves. We now come to the commission. My hon. Friend is a long-standing supporter of patient involvement. I take his words very seriously and I hope that they are read and understood outside the Committee—indeed, I am sure that they will be.
You allowed me to range widely in speaking on clause 160, Mr. Chope, and I do not want to repeat my argument. I attempted to convince the Committee that the changes proposed in these clauses represent an evolution of policy, notwithstanding the debate about abolition and the way in which the hon. Member for Hazel Grove saw it. I genuinely believe that this is a move in the right direction, which will benefit patient involvement.

Question put and agreed to.

Clause 162 ordered to stand part of the Bill.

Clause 163

Duty to consult users of health services

Alistair Burt: I beg to move amendment No. 206, in clause 163, page 117, line 4, at end insert—
‘(e) any other organisation contracted to provide care services;’.
The first amendment relating to this clause brings us back to familiar territory. In this case, we are simply trying to widen the duty of consultation in relation to what appears to be a restrictive list, which we have seen in other places in the Bill. The amendment would widen the duty to consult to include
“any other organisation contracted to provide care services.”
It is a simple recognition of the modern provision of health care. Will the Minister remind us why he does not feel that that needs to be included and why such bodies are not covered? That would be helpful.
To reiterate, we are seeking clarification on the clause to ensure that all the bodies that we wish to be involved in consultation are involved, just as earlier we wished such bodies to be inspected and to be able to respond to all the various other parts of the job of LINKs. The amendment would extend the power of consultation to include the other commissioning bodies.

Patrick Hall: I thought that the hon. Gentleman would take it in that way. Who knows? His proposal in amendment No. 206 may well be covered in other legislation, as he detected earlier from his ministerial experience. Does he agree, in terms of general common sense and use of English, that when such things happen in legislation, perhaps there could be a note stating, to help those reading the current draft, that there is a link somewhere else, so as to keep us in the picture?

Alistair Burt: That would be helpful, but those who work on Bills are under exceptional pressure, from my memory of those who work to assist Ministers in drafting and publishing clauses, and already have an enormous amount to do. Adding yet another aide-mÃ(c)moire for us might be asking them to go a little bit too far. Perhaps it could be covered in the notes to the legislation.
I think that we have made our point. This is a simple probing amendment to extend the duty to consult, unless the provision is already there somewhere else. I hope that the Minister will respond.

Phil Woolas: The answer to the hon. Gentleman’s question—I am grateful to him for giving me time to find it—is set out in section 242 of the National Health Service Act 2006. It covers both health and social care by using “care services”, which he used in amendments to previous clauses in part 11 of the Bill. We agree that the duty should be extended, which is why, as has been rightly said, the measures are an add-on to existing legislation.
The point about a note in the Bill was debated by the Modernisation Committee, and the explanatory notes provided work in that way. I understand that the hon. Gentleman’s point of view was resisted, and I add the other argument that it is helpful for the Minister to be able to draw on such examples to show that the policy is joined up. Section 242 of the National Health Service Act 2006 refers to section 11 of the Health and Social Care Act 2001.

Alistair Burt: The explanatory notes do, indeed, refer to section 242 of the 2006 Act, but do not indicate that that particular point was covered. My reading tonight must include section 242; then I will be, if not wiser, better informed the next time we discuss the measures. With that, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

John Pugh: I beg to move amendment No. 223, in clause 163, page 117, line 9, after “representatives”, insert
“which shall include Local Involvement Networks”.
Briefly, the amendment deals with proposed new section 242(1B) of the 2006 Act:
“Each relevant English body must make arrangements, as respects health services for which it is responsible, which secure that users of those services are, directly or through representatives, consulted on”.
We wish to include the words
“which shall include Local Involvement Networks”.
 The argument against our amendment is that that is tacitly understood or implied, but it is not actually spelled out, so the right of local involvement networks to be consulted at that point is not in the Bill. The amendment could be dealt with easily if the Minister expanded a little bit on the meaning of “representatives” and put on the record that the representatives would necessarily include the LINKs.

Phil Woolas: It does seem that a gap in the Bill may be created by not specifying the point that the hon. Gentleman is making. I will make it explicit that the NHS should consult. The Bill requires the NHS to consult LINKs. However, I recognise that it is a question of balance. Although we would expect NHS bodies to consult LINKs as a matter of course, the danger of singling them out in legislation is that it may provide cover to NHS organisations that only want to consult LINKs. There are examples of bodies only consulting the organisations specified in legislation.
The objective of Government policy would be that, in not too many years to come, organisations including LINKs would be consulted as a matter of course. It is a question of balance. We sought to ensure that NHS would consult LINKs through the mechanisms and procedures of contracts that we put in place. Specifying such a course of action may be used as an excuse not to consult other bodies. Much of the Bill is about the duty to consult and involve.

John Pugh: I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Alistair Burt: I beg to move amendment No. 207, in clause 163, page 117, line 11, leave out ‘significant’.

Christopher Chope: With this it will be convenient to discuss the following amendments:
No. 208, in clause 163, page 117, line 13, leave out ‘significant’.
No. 222, in clause 163, page 117, line 14, at end insert—
‘(1BA) for the purposes of subsection (1B)(c) decisions affecting the operation of services shall include any decision that changes the organisation responsible for any of the services that are delivered.’.
No. 209, in clause 163, page 117, leave out lines 15to 20.
No. 210, in clause 163, page 117, leave out lines 21to 26.
No. 233, in clause 163, page 117, line 26, at end insert—
‘(c) the physical access and travel to those services by users.’.
No. 217, in clause 163, page 117, leave out lines 27to 29.
No. 218, in clause 163, page 117, line 30, leave out ‘subsections (1B) to (1E)’ and insert ‘subsection (1B)’.

Alistair Burt: I shall be succinct, rather than brief, because this is a serious matter. To those of a suspicious cast of mind, the introduction into the clause of “significant” and “substantial” is worrying. Surely that indicates a mechanism by which consultation can be restricted. It appears that this is a mechanism to cut out concerns that were considered trivial when raised in the past by those on forums. Who is to decide what is substantial and significant? It is suggested that the provision will avoid needless consultation on trivial matters. However, there is a danger that those deciding what is significant and substantial may not have the same point of view as, for example, those representing patient interests.
As well as mentioning the representations that we have received from forums, I again draw attention to the submission made by the Commission for Patient and Public Involvement in Health, which has drawn attention to those concerns. It said:
“There is a crucial difference between this clause and the previous legislation”—
the aforesaid section 242. It continued:
“Whilst CPPIH welcomes the government’s recognition of the need for clarification of when the duty to consult applies, we are concerned that under the Bill’s proposals this duty may apply in only a narrow range of circumstances.”
We would echo that.

Patrick Hall: On the debate about the meaning of “significant”, the hon. Gentleman is probably aware that the Health Committee has considered this matter and suggested that “substantial” is better. However, I am not sure what the difference is. I am not trying to put the hon. Gentleman on the spot, but would he find that word more acceptable? If he does, it would be useful to know why.

Alistair Burt: The hon. Gentleman’s last point is the most important. I am at a loss to know why this change should be made and I am also at a loss to know what the Health Committee will say, because it has not reported. I am sure that he would agree that knowledge of the conclusions that it had come to would have informed this Committee. Be that as it may, the question is this: why has the measure been introduced? Surely it is a restriction of the ability to consult, which looks as though it is damaging to patient interests rather than permissive and helpful to them.

John Pugh: I shall speak briefly to amendment No. 233. Given what the Minister has said, I do not think that there is any doubt in the minds of anyone in the Committee that significant change could involve changes in access to travel arrangements. Amendment No. 233 would add an additional paragraph, following on from paragraphs (a) and (b) of proposed new subsection (1D).
Looking at paragraphs (a) and (b) led me to question whether we were adding anything new, because there is recognition that that sort of thing should be captured in the paragraphs. As best I read paragraphs (a) and (b), I could not see that they implied what I wanted to put in or that they were logically equivalent to it. Given the Minister’s previous emphasis on the importance of transport arrangements as an aspect of service delivery, I commend the amendment to the Committee.

Patrick Hall: I shall speak briefly to amendment No. 222, the purpose of which is to ensure that there is an explicit duty to consult on decisions to outsource health services. I do not mean cleaning or catering services, but health services.
The issue arises from the outcome of a judicial review that was brought last year by an individual against the decision of the North Derbyshire primary care trust to tender for the provision of a family doctor service in north Derbyshire, a proposal about which the trust did not consult the public. That led to intense ideological debate around the fact that the tender was won by a United States healthcare giant called United Health, known in this country as United Health Europe.
My amendment does not tread on that territory, however. It addresses the duty to consult users of health services and the outcome of the High Court judgment in June 2006 that the duty may apply to contractual changes. That outcome was not altered by the Court of Appeal’s judgment in August that the decision to award the contract be quashed and the tender process started again with public consultation. I want to ensure that changes in providers of health services which are proposed by primary care trusts are subject to the duty to consult.

Phil Woolas: The group of amendments is wide ranging. The hon. Member for North-East Bedfordshire was brief and concise, and raised an important point about the inclusion of the word “significant”. Let me explain where we are coming from. The changes that we are making are to section 242 of the National Health Service Act 2006, which was formerly section 11 of the Health and Social Care Act 2001. They are important changes, the reasons for which I should like to explain.
As it stands, section 242 is a wide-ranging duty on the NHS to involve and consult patients and the public. It does not recognise the different scale of changes, however, and the fact that it might not be meaningful for NHS bodies to apply the same duty to involve and consult for all the changes that they make, however minor they may be. Furthermore, without some kind of threshold, the duty has the potential—this is a genuine fear—to bring about that often heard complaint of consultation fatigue. We are trying to ensure that the changes to service delivery that affect patients and service users are subject to consultation, but that minor, day-to-day decisions, which we fear could be subject to mischievous or vexatious interpretation, are not. By inserting the threshold, we are aiming to ensure that when a change has a significant impact on the range of services and the manner of their delivery, the consultation required by section 242 is undertaken. Without such a threshold, we fear that NHS bodies would have to consult patients and the public on even the most trivial changes.

Alistair Burt: Who decides a dispute? What happens if LINKs believe that a change is significant, but those who are delivering it do not?

Phil Woolas: The scrutiny regime that is being created would have a view on whether a change was significant. It would ultimately be a matter for legal interpretation. The professional inspectorate would also have a view of what constituted a significant change. If a hospital seeks to hide behind the idea of significance by saying that a change is not significant, we would point to those aspects of the legislation that refer to the delivery of services. The Government are attempting to take away some of the management operational decisions of trusts—I would not quite call them trivial—as opposed to the direct delivery of services.

Andrew Stunell: I suspect that everybody in the Committee understands that there is a level of triviality to which consultation ought not to descend. However, hon. Members will know of plenty of examples of individual cases that may in themselves be insignificant, but which have a much broader application. For example, complaints about a particular ward on a particular day may be said to be trivial or insignificant, but may be part of a broader pattern. Will the Minister throw some light on the grey area that the current wording of the Bill creates?

Phil Woolas: My argument is not that day-to-day management decisions do not have an impact on patient services, and I hope that it has not been interpreted that way. In some instances, such decisions can and do impact on patient services. By giving examples, I might be better able to explain the intent behind the measure. In every case, whether an issue is significant or substantial will be determined by a number of factors. A reduction in bed numbers, for example, might result from there being too much capacity in the hospital, or because there are other means of providing care that makes a number of beds superfluous. A GP may change their opening hours because services are being provided in a different way, but without any noticeable change for patients. NHS bodies will need to weigh up each case and apply the threshold appropriately.
The key is to ensure that patients and the public are properly consulted in planning for the provision of services. That is important in relation to section 242. The measure allows NHS bodies to plan and deliver effective consultation activity that is more likely to be meaningful to the patients and members of the public that it will involve. The crucial argument is about what affects patient services, the planning of decisions by NHS bodies, and the consultation of public and patients. The definitions of the words “significant” and “substantial” are open to interpretation, as with the word “reasonable” in a court of law. Cases on the cusp of the definitions will give rise to controversy. The Government are trying to ensure that there is meaningful consultation over the planning for the provision of services.
Amendment No. 218 is a consequential amendment that follows on from amendments Nos. 209 and 210, so I do not need to speak to it.
Having looked carefully at amendment No. 222, we consider that it will have no effect on what the clause already provides. If there is a change in the provider of services, the requirement to consult already applies assuming that there will be a substantial impact on the manner in which the services are delivered to their users. If, as I believe, the amendment is intended to extend that to any change of service provider, even if it has no effect on the manner in which services are delivered to users, we do not support that. It is likely that service providers will change over time, but just because a provider changes that does not necessarily mean that the service will too. We do not believe that it is sensible to consult patients and the public when the only change is to the name of the organisation providing a service.

Patrick Hall: Does my hon. Friend not acknowledge that even if what he says about the service not deteriorating or changing is absolutely right—presumably the reason for changing the provider is to improve the service—it is legitimate for the public to be concerned and ask questions about what might in some cases be perceived as the privatisation of national health services? Surely that is a perfectly legitimate matter for the public and others to engage in.

Phil Woolas: My hon. Friend is right, but he seeks to add new subsection (1BA) after new subsection (1B). My argument is that his proposed subsection would add no additional meaning to new subsection (1B)(c). The
“significant decisions to be made by that body affecting the operation of those services”
could cover my hon. Friend’s point. The amendment would therefore have no effect on the meaning and intent of the clause.
My argument on amendment No. 217 is similar. As I understand it, the proposal is to consult patients and the public on something that may or may not have an impact on services actually received by users; for example, if a change of service provider might result in a change of service. The clause currently gives us something far more meaningful: the requirement to consult on something that will have an impact on services.
Amendment No. 233 would include in new subsection (1D)
“the physical access and travel to those services by users.”
As I said about an earlier amendment tabled by the hon. Member for Southport, I believe that that is already adequately covered in the Bill. I refer him to new subsection (1D)(a), which refers to
“the manner in which the services are delivered to users of those services”,
which covers his point about travel.
Having considered the amendments, I ask hon. Members not to press them, as they are unnecessary and their provisions are already covered in the Bill.

Alistair Burt: The offer of some degree of guidance by way of examples and the threat of further scrutiny of decisions on what is significant or substantial and what is not are helpful. As always, the Minister’s good intentions will be judged on how that works out in practice. I am content with what I have heard and I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 163 ordered to stand part of the Bill.

Clause 164

Primary Care Trusts: reports on consultation

John Pugh: I beg to move amendment No. 234, in clause 164, page 118, line 10, at end insert—
‘(c) on any disagreements between the Trust and the Local Involvement Network or a Local Health Overview and Scrutiny Committee.’.
I am aware that Members selflessly give up their lunch as part of their duties during Committee. I am reluctant to have them give up their dinner as well, so I shall be very brief.
The clause states that primary care trusts must produce a report on the consultation that they have carried out and the influence that it has had on commissioning. The amendment suggests that, as part of this, they highlight any major disagreements between the overview and scrutiny committee and the PCT, and between the PCT and the LINKs.
The amendment was tabled because that is precisely what they would be most reluctant to do, but precisely where the areas of concern would be, and where consultation would have failed.
Having examined my amendment, I must say that I wish I had included the word “significant”, because as it is drafted at the moment, it would seem to force them to list almost any disagreement of whatever type. Therefore, if it helps, I will pre-emptively withdraw the amendment. However, if the Minister wishes to respond, we will hear him out.

Christopher Chope: I must propose the question, in case the Minister wishes to respond. Does the Minister wish to respond?
 Mr. Woolas indicated dissent.

John Pugh: I beg to ask leave to withdraw the amendment.

Amendment withdrawn.

Clause 164 ordered to stand part of the Bill.
 Further consideration adjourned.—[Jonathan Shaw.]

Adjourned accordingly at sixteen minutes pastSeven o’clock till Thursday 8 March at half-pastNine o’clock.